HIPAA compliance checks
100%
+0%
Auto-approved auths
62%
+5%
Prior-auth turnaround
4h 12m
-37%
Eligibility success
98.7%
+0.6%
Provider Ops
Verify eligibility, gather clinical criteria, submit 278 & receive notifier, schedule care.
- PII redaction + audit trail
- FHIR/HL7 + X12-aware prompts
- Human handoff when needed
Payer UM/CM
Utilization management scripting; policy-aligned approvals; avoid abrasion with smart KBA.
- PII redaction + audit trail
- FHIR/HL7 + X12-aware prompts
- Human handoff when needed
Member Outreach
Reminders, prep instructions, benefits guidance—ES/PT/EN, voice/chat/email.
- PII redaction + audit trail
- FHIR/HL7 + X12-aware prompts
- Human handoff when needed